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​Privacy Policy

Effective Date: 01/12/2025 

 

This Notice describes how your medical information may be used and disclosed, and how you can access this information. Please review it carefully. 

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Your Rights 

You have the right to:   

  • Receive a copy of your medical records.    

  • Request corrections to your records.       

  • Request confidential communications.      

  • Limit what information we share.    

  • Ask for a list of certain disclosures.      

  • Receive a paper copy of this notice at any time.      

  • File a complaint without fear of retaliation if you believe your privacy rights have been violated. 

 

 

Our Uses and Disclosures 

 

We may use and share your health information for: 

 

Treatment: To provide and coordinate your care. 

 

Payment: To receive payment for your services (not applicable to Medicare or insurance claims if you are under a cash-pay agreement). 

 

Healthcare Operations: For quality improvement, staff training, and compliance activities. 

 

Legal Requirements: When required by law (e.g., public health reporting, law enforcement, court orders). 

 

 

We will not use or share your information for marketing, fundraising, or the sale of your information without your written authorization. 

 

 

Our Responsibilities 

 

  • We are required by law to maintain the privacy and security of your Protected Health Information (PHI). 

  • We must notify you promptly if a breach occurs that may compromise your information. 

  • We will follow the duties and privacy practices described in this notice. 

  • We will not use or share your information other than as described here unless you give written permission. 

 

Questions or Complaints 

 

If you have questions, or if you believe your privacy rights have been violated, you may contact: 

 

Email: manager@1on1athomept.com

Phone: 917-617-8290

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You may also file a complaint with the U.S. Department of Health & Human Services (HHS), Office for Civil Rights at www.hhs.gov/ocr/privacy. We will not retaliate against you for filing a complaint. 

 

 

Acknowledgment of Receipt 

I acknowledge that I have received and reviewed the Notice of Privacy Practices. 

 

Patient/Client Signature: __________________________ Date: ___________ 

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